AP-NOSES: A Prospective Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery

Recruiting now

Conditions studied: Colorectal Neoplasms, Incisional Hernia

In brief

Natural orifice specimen extraction (NOSE) is a minimally invasive colorectal surgical technique in which the surgical specimen is removed through a natural orifice, including transanal or transvaginal routes, thereby avoiding an abdominal extraction incision. Observational studies suggest that NOSE may reduce wound-related morbidity and improve postoperative recovery, but prospective multicenter data evaluating long-term outcomes remain limited. AP-NOSES is a prospective, multicenter observational registry evaluating clinical, patient-reported, and long-term wound outcomes following minimally invasive colorectal surgery with NOSE or transabdominal specimen extraction. The primary objective is to compare time to incisional hernia within 24 months between NOSE-eligible patients undergoing planned NOSE extraction and NOSE-eligible patients undergoing planned transabdominal extraction. Secondary objectives include evaluation of postoperative complications, extraction-related morbidity, bowel function, urinary and sexual function, oncologic outcomes, and long-term patient-reported and clinical outcomes across participating centers. This study does not alter routine clinical care. Surgical technique, perioperative management, and follow-up are performed according to local institutional practice.

Key facts

Study ID

NCT07615036

Run by

Singapore General Hospital

People needed

800

Starts

2026-05-05

Expected to finish

2033-12-30

Last updated by the study team

2026-05-29

Who can join

Age: 21 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Age 21 years or older
• Elective minimally invasive colorectal resection (laparoscopic or robotic intent)
• Planned intact specimen extraction
• Eligible for natural orifice specimen extraction (NOSE) or transabdominal specimen extraction according to study protocol
• Ability to provide informed consent

You may not qualify if…

• Emergency colorectal surgery
• Planned transanal total mesorectal excision (TaTME)
• Planned ultralow anterior resection with planned anastomosis 3 cm or less from the anal verge
• Planned abdominoperineal resection (APR)
• Planned permanent end stoma without restoration of intestinal continuity
• Planned multivisceral resection
• Generalized peritonitis or uncontrolled intra-abdominal sepsis
• Pregnancy
• Pre-existing ventral or incisional hernia at the planned extraction site
• Planned specimen extraction through a prior laparotomy incision containing mesh
• Fixed distal obstruction, severe pelvic stenosis, or other anatomical constraint precluding intact specimen extraction

Where it is running

• Singapore General Hospital — Singapore, Singapore (enrolling)

Full record on ClinicalTrials.gov

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